Connectome architecture shapes large-scale cortical alterations in schizophrenia: a worldwide ENIGMA study.

Schizophrenia is a prototypical network disorder with widespread brain-morphological alterations, yet it remains unclear whether these distributed alterations robustly reflect the underlying network layout. We tested whether large-scale structural alterations in schizophrenia relate to normative structural and functional connectome architecture, and systematically evaluated robustness and generalizability of these network-level alterations. Leveraging anatomical MRI scans from 2439 adults with schizophrenia and 2867 healthy controls from 26 ENIGMA sites and normative data from the Human Connectome Project (n = 207), we evaluated structural alterations of schizophrenia against two network susceptibility models: (i) hub vulnerability, which examines associations between regional network centrality and magnitude of disease-related alterations; (ii) epicenter mapping, which identifies regions whose typical connectivity profile most closely resembles the disease-related morphological alterations. To assess generalizability and specificity, we contextualized the influence of site, disease stages, and individual clinical factors and compared network associations of schizophrenia with that found in affective disorders. Our findings show schizophrenia-related cortical thinning is spatially associated with functional and structural hubs, suggesting that highly interconnected regions are more vulnerable to morphological alterations. Predominantly temporo-paralimbic and frontal regions emerged as epicenters with connectivity profiles linked to schizophrenia's alteration patterns. Findings were robust across sites, disease stages, and related to individual symptoms. Moreover, transdiagnostic comparisons revealed overlapping epicenters in schizophrenia and bipolar, but not major depressive disorder, suggestive of a pathophysiological continuity within the schizophrenia-bipolar-spectrum. In sum, cortical alterations over the course of schizophrenia robustly follow brain network architecture, emphasizing marked hub susceptibility and temporo-frontal epicenters at both the level of the group and the individual. Subtle variations of epicenters across disease stages suggest interacting pathological processes, while associations with patient-specific symptoms support additional inter-individual variability of hub vulnerability and epicenters in schizophrenia. Our work outlines potential pathways to better understand macroscale structural alterations, and inter- individual variability in schizophrenia.

Mapping gray and white matter volume abnormalities in early-onset psychosis: an ENIGMA multicenter voxel-based morphometry study.

INTRODUCTION: Regional gray matter (GM) alterations have been reported in early-onset psychosis (EOP, onset before age 18), but previous studies have yielded conflicting results, likely due to small sample sizes and the different brain regions examined. In this study, we conducted a whole brain voxel-based morphometry (VBM) analysis in a large sample of individuals with EOP, using the newly developed ENIGMA-VBM tool. METHODS: 15 independent cohorts from the ENIGMA-EOP working group participated in the study. The overall sample comprised T1-weighted MRI data from 482 individuals with EOP and 469 healthy controls. Each site performed the VBM analysis locally using the standardized ENIGMA-VBM tool. Statistical parametric T-maps were generated from each cohort and meta-analyzed to reveal voxel-wise differences between EOP and healthy controls as well as the individual-based association between GM volume and age of onset, chlorpromazine (CPZ) equivalent dose, and other clinical variables. RESULTS: Compared with healthy controls, individuals with EOP showed widespread lower GM volume encompassing most of the cortex, with the most marked effect in the left median cingulate (Hedges' g = 0.55, p = 0.001 corrected), as well as small clusters of lower white matter (WM), whereas no regional GM or WM volumes were higher in EOP. Lower GM volume in the cerebellum, thalamus and left inferior parietal gyrus was associated with older age of onset. Deficits in GM in the left inferior frontal gyrus, right insula, right precentral gyrus and right superior frontal gyrus were also associated with higher CPZ equivalent doses. CONCLUSION: EOP is associated with widespread reductions in cortical GM volume, while WM is affected to a smaller extent. GM volume alterations are associated with age of onset and CPZ equivalent dose but these effects are small compared to case-control differences. Mapping anatomical abnormalities in EOP may lead to a better understanding of the role of psychosis in brain development during childhood and adolescence.

Impact of intimate partner violence on quality of life and disease activity in women with systemic lupus erythematosus.

OBJECTIVE: Stress and trauma are psychosocial factors with an impact on the course of systemic lupus erythematosus (SLE). The influence of violence on SLE has not been entirely explored, even though women (including patients with rheumatic diseases) are a vulnerable population to any form of violence. This study aims to assess the prevalence and impact of intimate partner violence (IPV) on health-related quality of life in women with SLE. METHODS: An observational, cross-sectional, and analytical study was conducted at a rheumatology clinic of a university hospital from September 2022 and September 2023. We evaluated the presence of IPV in 85 women with SLE with the Hurt, Insulted, Threatened with Harm and Screamed at (HITS) questionnaire and the Index of Spouse Abuse (ISA), and quality of life with LupusQoL. RESULTS: The prevalence by HITS score of past-year IPV was 24.4% and of lifetime IPV was 36.5%. Past-year non-physical violence was present in 17.1% of patients by ISA, and 27.1% were victims in their lifetime. While in physical violence, 7.3% were victims in the previous year and 21.2% in their lifetime. The total quality of life and the emotional domain by LupusQoL were diminished in victims of past-year IPV, compared to those who weren't exposed (p = .018 and p = .036, respectively). Past-year HITS score correlated with the Physician Global Assessment (PGA) (rho = 0.301, p = .006), while lifetime HITS score correlated with PGA (rho = 0.329, p = .002) and SLEDAI-2K (rho = 0.277, p = .010). CONCLUSION: We found that one in four women suffered IPV in the previous year, and those who were exposed had diminished quality of life. Also, the severity of the abuse correlated with disease activity. Our findings emphasize the importance of comprehensive care for patients with SLE.

Sexual dysfunction and self-perceived sexual health in patients with rheumatoid arthritis and systemic lupus erythematosus: results from a cross-sectional survey.

Sexual dysfunction (SD) has been associated with worse quality of life and higher disease activity in patients with rheumatic diseases, yet it is still not regularly addressed during routine rheumatologic evaluations. This study aimed to determine the prevalence of sexual dysfunction in patients with rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) and evaluate their perception of their sexual health. We performed a retrospective study in an outpatient rheumatology clinic to evaluate patients over 18 years old with a diagnosis of RA or SLE through the Spanish version of the Arizona Sexual Experiences Scale (ASEX) and the Sexual Health Perception Survey (SHEPS), a questionnaire of 6 items designed in our clinic. Additionally, we applied the Functional Assessment of Chronic Illness Therapy - Fatigue (FACIT-F version 4) and the Hospital Anxiety and Depression Scale (HADS). A total of 567 patients were evaluated with SHEPS, most of whom were women with a median age of 50 years (IQR: 34) and a median disease duration of 5 years (IQR: 9). Through the ASEX, we found that 67% of the patients with RA and 60% of the patients with SLE experienced SD. Patients reported the level of sex drive, arousal, and the ability to achieve orgasms as the areas with the most difficulties. Most patients did not know their disease could affect their sexuality and had never addressed these issues with their rheumatologists, but almost all of them were willing to. Our findings highlight the importance of addressing sexual health issues regularly during rheumatologic evaluations.

"I'm Done": A patient's wish and will to die.

BACKGROUND: A desire for hastened death is commonly expressed by cancer patients. Although efforts to define and explore this issue have been undertaken, no standardized approach exists to address these desires. CASE DESCRIPTION: Ms. J expressed a wish for accelerated death and subsequently experienced unexpected clinical decline resulting in a quick, natural death. Our team experienced a mixture of both emotional distress and awe after witnessing the pragmatic approach our patient had to her impending decline, that we felt was worthy of further exploration. CONCLUSION: Most clinicians lack formal training in communication, potentially making cases like Ms. J's highly distressing. Clinicians should feel comfortable addressing and potentially inquiring about patients' desire to hasten death. While our initial reaction might be to correct this desire, we propose reframing this expression as an opportunity to explore more about our patients.

You get what you test for: The killing effect of phage lysins is highly dependent on buffer tonicity and ionic strength.

The phage lysin field has done nothing but grow in the last decades. As a result, many different research groups around the world are contributing to the field, often with certain methodological differences that pose a challenge to the interpretation and comparison of results. In this work, we present the case study of three Acinetobacter baumannii-targeting phage lysins (wild-type endolysin LysMK34 plus engineered lysins eLysMK34 and 1D10) plus one lysin with broad activity against Gram-positive bacteria (PlySs2) to provide exemplary evidence on the risks of generalization when using one of the most common lysin evaluation assays: the killing assay with resting cells. To that end, we performed killing assays with the aforementioned lysins using hypo-, iso- and hypertonic buffers plus human serum either as the reaction or the dilution medium in a systematic manner. Our findings stress the perils of creating hypotonic conditions or a hypotonic shock during a killing assay, suggesting that hypotonic buffers should be avoided as a test environment or as diluents before plating to avoid overestimation of the killing effect in the assayed conditions. As a conclusion, we suggest that the nature of both the incubation and the dilution buffers should be always clearly identified when reporting killing activity data, and that for experimental consistency the same incubation buffer should be used as a diluent for posterior serial dilution and plating unless explicitly required by the experimental design. In addition, the most appropriate buffer mimicking the final application must be chosen to obtain relevant results.

The New SH3b_T Domain Increases the Structural and Functional Variability Among SH3b-Like CBDs from Staphylococcal Phage Endolysins.

Endolysins, proteins encoded by phages to lyse their hosts and release their progeny, have evolved to adapt to the structural features of each host. The endolysins from Staphylococcus-infecting phages typically feature complex architectures with two enzymatically active domains (EADs) and one cell wall-binding domain (CBD) belonging to the bacterial SH3 (SH3b) superfamily. This study focuses on three SH3b-like CBDs from representative staphylococcal phage endolysins (LysRODI, LysC1C and LysIPLA5) that were structurally and functionally characterized. While RODI_CBD and C1C_CBD were assigned to the well-known SH3_5 family, a new family, SH3b_T (PF24246), was identified using the CBD from LysIPLA5 as a model. GFP-fused CBDs were created to assess their differential binding to a collection of staphylococcal strains. IPLA5_CBD showed enhanced binding to Staphylococcus epidermidis, while RODI_CBD and C1C_CBD exhibited distinct binding profiles, with RODI_CBD targeting Staphylococcus aureus specifically and C1C_CBD displaying broad binding. Sequence comparisons suggested that a few differences in key amino acids could be responsible for the latter binding difference. The CBDs modulated the activity spectrum of synthetic EAD-CBD combinations in accordance with the previous binding profiles, but in a manner that was also dependent on the EAD present in the fusion protein. These results serve as a context for the diversity and versatility of SH3b domains in staphylococcal endolysins, providing insights on how (i) the CBDs from this superfamily have diverged to adapt to diverse bacterial ligands in spite of sharing a common fold; and (ii) the evolution of specificity relies on the EAD-CBD combination rather than solely the CBD.

Probióticos: una mirada al mecanismo de acción y aplicaciones clínicas en Pediatría

Introducción: Los probióticos son microorganismos vivos que brindan beneficios al huésped mediante diversos mecanismos de acción. Han sido fuente de estudio en diversas patologías pediátricas, mostrando algunos resultados prometedores. Objetivo: Elaborar una revisión de la literatura sobre los mecanismos de acción y la evidencia actual que tienen los probióticos sobre la salud infantil. Materiales y métodos: Se realizó una revisión narrativa de la literatura con estrategia de búsqueda sistemática de la literatura con términos MESH acerca de los mecanismos de acción de los probióticos y su uso. Se incluyeron metaanálisis, revisiones sistemáticas y ensayos clínicos aleatorizados. Resultados: Los probióticos son una nueva herramienta terapéutica usada para mejorar la salud infantil. Se ha encontrado efecto benéfico en diarrea, en enterocolitis necrosante con una disminución significativa de la mortalidad y se ha mostrado evidencia significativa en las horas de llanto en cólico del lactante. Conclusión: Se requieren más estudios en otro tipo de enfermedades como estreñimiento y en algunos procesos alérgicos e inflamatorios. Los ensayos revisados ofrecen un panorama prometedor, pero la elección de un probiótico debe ser personalizado de acuerdo con la edad, enfermedad, cepa y dosis, dado que cada uno de ellos tiene múltiples mecanismos de acción que impactan de manera diferente en la eficacia clínica.

Introduction: Prebiotics are living microorganisms that provide benefits to the host through various mechanisms of action. They have been a source of study in various pediatric pathologies showing some promising results. Objective: To prepare a review on the mechanisms of action and current evidence that prebiotics have on child health. Materials and methods: A narrative review of the literature was carried out with a systematic literature search strategy with MESH terms about the mechanisms of action of probiotics and their use. Meta-analyzes, systematic reviews, and randomized clinical trials were included. Results: Probiotics are a new therapeutic tool used to improve children's health. A beneficial effect has been found in diarrhea, in necrotizing enterocolitis with a significant decrease in mortality and significant evidence has been shown in the hours of crying in colic in infants. Conclusion: The trials reviewed offer a promising picture, but the choice of a probiotic must be customized according to the age, disease, bacterial strain and dose, since each one has different action mechanisms and clinical effectiveness. More studies are required in some allergic and inflammatory diseases.

Communication management in social responsibility programs in the mining sector / Gestión de la comunicación en programas de responsabilidad social en el sector minero

RESUMEN La responsabilidad social, como una de las respuestas a los actuales conflictos socioambientales, implica esfuerzos adicionales de las organizaciones para fortalecer su capacidad de gestión. Esto sucede, de manera especial, en las compañías mineras, cuyas actividades comprometen el uso de recursos de comunidades, entre ellos los naturales. Esta investigación analizó los aportes que la gestión de comunicaciones hace al relacionamiento con las comunidades en el marco de dos programas de responsabilidad social de los proyectos mineros Quebradona y Gramalote (ubicados en Antioquia, Colombia), adscritos a la compañía Anglogold Ashanti y ganadores del Premio Sello Social a la Minería en Antioquia, siendo dos de los proyectos con mayor exigencia y veeduría ciudadana en la región. Desde una mirada con predominancia interpretativa, y acudiendo a la revisión de documentos y entrevistas a jefes de áreas sociales, comunicadores, beneficiarios y líderes ambientales, se concluyó que el análisis del entorno, la visibilización de los programas y la mediación en los conflictos socioambientales son los principales aportes de los comunicadores en los proyectos mineros.

ABSTRACT Social responsibility, as one of the responses to current sock-environmental conflicts, implies additional efforts by organizations to strengthen their management capacity. This happens, especially, in mining companies, our activities compromise the use of community resources, including natural resources. This research analyzed the contributions that communications management makes to relations with communities within the framework of two social responsibility programs of the Quebradona and Gramalote mining projects (located in Antioquia, Colombia), attached to the company Anglogold Ashanti and winners of the Premio Sello Social a la Minería en Antioquia, being two of the projects with the highest demand and citizen oversight in the region. From an interpretive perspective and going to the review of documents and interviews with heads of social areas, communicators, beneficiaries, and environmental leaders, it was concluded that the analysis of the environment, the visibility of the programs and mediation in socio-environmental conflicts are the main contributions of communicators in mining projects.

Enfermedades respiratorias crónicas y su relación con patrones espirométricos / Chronic respiratory diseases and their relationship with spirometric patterns

Introducción.Las patologías pulmonares crónicas en Guayaquil son un problema que aqueja a los pacientes atendidos en el servicio de Neumología del Hospital Luis Vernaza, hasta el momento no se cuenta con una base de datossobre enfermedades respiratorias y de patronesespirométricos en pacientes que presentan dichas patologías a pesar de ser un hospital de tercer nivel y de referencia nacional. Objetivo.Determinar las patologías respiratorias crónicas y su relación con los patrones espirométricos en pacientes atendidos en el Hospital Luis Vernaza, de enero ­diciembre 2015. Materiales y métodos.Fue de diseño no experimental, descriptivo, correlacional. El universo y muestra fueron los pacientes que asistieron a la consulta externa del servicio de Neumología del Hospital Luis Vernaza. Se tomaron datos de la historia clínica de los pacientes que durante la fecha indicada asistieron a la consulta externa del servicio de Neumología, se llenaron las hojas de recolección de datos y luego se tabularon los resultados. Resultados.En relación con las enfermedades respiratorias, las más frecuentes fueron el asma bronquial 29%, y EPOC 26%. Entre los patrones espirométricos, el patrón normal tuvo 38%, patrón obstructivo 33%, y el patrón restrictivo 29%. Los pacientes con asma bronquial presentaron 45,5% patrones obstructivos, y en pacientes con EPOC 41,1% con patrones restrictivos. Conclusiones. La enfermedad respiratoria crónica más frecuente fue el asma bronquial. En los patrones espirométricos, el patrón normal fue en otras enfermedades respiratorias, mientras que en el asma bronquial el patrón más frecuente fue el obstructivo y en el EPOC el patrón restrictivo.

Introduction. Pulmonary diseases in Guayaquil is a problem that afflicts patients seen in theservice of Pulmonology of the Luis VernazaHospital, so far there is no database on respiratory diseases and spirometric patterns in patients with these pathologies, despite being a third level hospital and of national reference. Objective.Determine the respiratory pathologies and their spirometric patterns in patients attended at the Luis VernazaHospital, from January -December 2015. Materials and methods.This was non-experimental, descriptive, correlational study. The universe and sample were patients who attended the external consultation of the pulmonology department of the Luis VernazaHospital. Data were taken from the medical records of patients attended the external consultation of the service of pneumology; the data collection sheet was filled and then tabulated the results. Results.In relation to respiratory diseases, the most frequent were bronchial asthma 29%, and COPD 26%. Among the spirometric patterns, thenormal pattern had 38%, obstructive pattern 33%, and restrictive pattern 29%. Patients with bronchial asthma presented 45,5% obstructive patterns, and in patients with COPD 41,1% with restrictive patterns.Conclusions.The most frequent respiratory disease was bronchial asthma. In the spirometric patterns, the normal pattern was in other respiratory diseases, whereas in bronchial asthma the most frequent pattern was obstructive and in COPD the restrictive pattern.

Trombosis focal de vena femoral común: manifestación (jjVmssMark inicial de linfoma no Hodgkin difuso de células grandes B / Focal thrombosis of common femoral vein: initial manifestation of diffuse large B cell lymphoma

Resumen La trombosis venosa profunda (TVP) es una enfermedad frecuente que afecta anualmente al 0,1-0,3% de la población general; además es una causa importante de morbimortalidad en el paciente oncológico. La TVP se produce con más frecuencia en la fase de tratamiento en la que se asocian los efectos protrombóticos del proceso neoplásico y de la quimioterapia. En un menor número de casos se identifica en el diagnóstico o incluso puede ser su primer síntoma. Una TVP focal secundaria a compresión extrínseca y desestructuración de los tejidos circundantes eleva la sospecha de un proceso maligno. Se presenta un caso de TVP focal como primomanifestación de un linfoma no Hodgkin difuso de células grandes B.

Abstract Deep venous thrombosis (DVT) is a common disease that annually affects 0.1-0.3% of the general population; It is also a significant cause of morbidity and mortality in cancer patients. DVT occurs more frequently in the treatment phase in which they are associated with the neoplastic prothrombotic process and effects of chemotherapy. In a small number of cases it is identified in the diagnosis or it may even be its first symptom. A secondary focal DVT extrinsic compression and destruction of surrounding tissue raises the suspicion of a malignant process. A case is presented of a focal DVT that was the first manifestation a non-Hodgkin's diffuse large B-cell lymphoma.

Vesícula biliar gigante / Giant gallbladder

Se registra el caso de una paciente femenina de 73 años con antecedente de colecistitis crónica, quien al examen físico presentaba una tumoración palpable en hipocondrio derecho que se extendía a fosa ilíaca derecha. La ecografía abdominal mostró aumento del tamaño vesicular que alcanzaba fosa ilíaca derecha con contenido multilitiásico; se confirmó dicho hallazgo con estudio tomográfico. Se realizó laparotomía exploradora con hallazgo operatorio de vesícula gigante de paredes engrosadas, tensa, adherida a órganos circundantes, de dificultosa disección, que requirió punción para drenaje de su contenido. Se efectuó, además, colecistectomía convencional según técnica de Pribram, y se obtuvo una pieza quirúrgica de aproximadamente 15 × 10 cm, con informe de anatomía patológica de colecistitis crónica. En contraste con la presentación habitual de la colecistitis crónica, el caso de referencia obedece a una presentación atípica con una vesícula gigante.

We report the case of a 73-year old female patient with a history of chronic cholecystitis with a palpable mass extending from the right hipochondrium to the right iliac region. An abdominal ultrasound showed an enlarged gallbladder extending to the right iliac region with multiple gallstones confirmed by computed tomography scan. An exploratory laparotmy was performed. A giant gallbladder with thickened walls and presence of adhesions to the neighbor organs that were difficult to remove were found and required drainage. A conventional cholecystectomy was performed using the Pribram's technique. A surgical specimen measuring 15 x 10 cm was sent to the pathologist who made a diagnosis of chronic cholecystitis. This case is an atypical presentation of chronic cholecystitis due to a giant gallbladder.

Las prácticas de enseñanza del profesor universitario, una herramienta efectiva para el éxito pedagógico / Teaching practices, an effective tool for pedagogic success

Resumen Este escrito tiene la intención de abordar las prácticas de enseñanza en el contexto de la formación en la educación superior, partiendo de la definición de didáctica como las diversas estrategias que tiene el docente para enseñar, siguiendo una ruta narrativa y argumentativa sobre su fundamentación para luego explorar la dimensión de esta disciplina en el aula y en las formas de enseñanza que desarrollan los maestros en su práctica. Los hallazgos principales dentro de las prácticas de enseñanza permiten valorar referentes como la selección de contenidos, las estrategias de comunicación, los recursos, el desarrollo metodológico y la relación profesor estudiante; esto en términos de saberes, creencias, preconcepciones, desde los cuales el docente estructura y dirige la práctica educativa. En este sentido, la didáctica desempeña un rol primordial, ya que indica las formas para llevar a cabo el proceso de enseñanza. Por otra parte, la configuración didáctica puede realizarse desde un discurso general, pero debe especializarse al interior de cada disciplina. Le corresponde a cada docente convertirse en investigador de sus propias prácticas de enseñanza, no sólo para validarlas o revaluarlas, sino para aportar en la reflexión que converja hacia la construcción del conocimiento.

Summary This paper aboards the teaching practices in the context of training in higher education, from the definition of didactics as the strategies the teacher has to teach, following narrative and argumentative routes about its grounds and then explore the dimensions of this discipline in the classroom and in the ways of teaching that teachers develop in their practices. The main findings in teaching practices allow valuate aspects concerning the content selection, communication strategies, resources, methodological development and teacher student relationship; this in terms of knowledge, beliefs, preconceptions, from which the teacher structure and conducts educational practice. In this way, didactics play a primary role, because it indicates the ways to carry out this process. Moreover, the didactical configuration can be performed from a general speech, but must be specialized within each field. It is up to each teacher to become a researcher ofits own teaching practices, to not only validate or evaluate them, but to contribute in the discussion that converges towards the construction of knowledge.

Variaciones de aa arteria del nodo sinoatrial en población Colombiana / Sino-atrial node artery variation in a sample of the Colombian population

Antecedentes. El conocimiento exacto de la integración anatomofisiológica del sistema de conducción del corazón, es fundamental para la comprender la fisiopatología, el diagnóstico y el manejo de muchas de las complicaciones de la enfermedad coronaria y de las cardiopatías en general. Uno de los aspectos fundamentales, más variable y con mayores repercusiones clínicas corresponde al origen y recorrido de las arterias encargadas de irrigar el nódulo sinoatrial. Objetivo. Determinar el origen, recorrido y distribución de las arterias que irrigan el nódulo sinoatrial en una muestra de población colombiana. Material y métodos. La muestra de análisis fueron 60 bloques cardiopulmonares y digestivos seleccionados a través de muestreo por conveniencia. A estos se les realizó una disección convencional de los genitales para la determinación del sexo y posteriormente se procedió con la disección de las arterias coronarias específicamente de la arteria del nódulo sinoatrial, con el fin de establecer su origen y recorrido. Resultados. Como hallazgo principal se encontró que el origen de la arteria del nódulo sinoatrial en 75% provenía de la coronaria derecha, un 15% procedía de la arteria circunfleja y el 10% restante fue codominante. En cuanto al trayecto 86,6% fueron lineales, mientras 13,4% tuvieron formas alternas como Y, doble Y o en tridente. Conclusiones. Se evidenció predominio del origen de la arteria del nódulo sinoatrial en la coronaria derecha, hallazgo coincidente con investigaciones similares e independiente de la procedencia geográfica y el origen racial. Sin embargo, en este estudio se evidenciaron recorridos no reportados en la literatura como la distribución en Y, en doble Y, en K invertida y en tridente.

Background. Accurate knowledge regarding the cardiac conduction system's anatomical-physiological integration is essential for understanding the pathophysiology, diagnosis and management of many complications regarding coronary disease and heart disease in general. One of the more variable fundamental aspects, having the greatest clinical impact, concerns the origin and course of arteries irrigating the sino-atrial node (SAN). Objective. Determining the origin, course and distribution of arteries supplying the SAN in a sample of the Colombian population. Materials and methods. 60 cardiopulmonary and digestive blocks were taken by convenience sampling. Conventional dissection of the genitalia determined gender; the coronary artery was then dissected, specifically the SAN, to establish origin and route. Results. It was found that 75% of the SAN artery's blood supply came from the right coronary artery (RCA), 15% from the circumflex artery and 10% was co-dominant. 86.6% of courses were linear; 13.4% were Y-shaped or Y-and double trident shaped. Conclusions. The prevalence of SAN artery origin in the RCA in this study was consistent with similar research findings, regardless of geographical and racial origin. However, this study report some courses not previously described in the literature, such as Y-, double Y-, inverted K- and trident-shaped forms.

Cuerpo extraño incidental en tracto gastrointestinal: Reporte de tres casos y revisión de la literatura / Incidental foreign body in the gastrointestinal tract: Report of three cases and literature review

La ingestión de cuerpo extraño es una condición frecuente en los servicios de urgencias. Aunque la mayoría de los objetos son eliminados sin causar sintomatología, algunas veces producen manifestaciones según la localización y las características del mismo o pueden pasar desapercibidos y producir complicaciones severas que amenazan la vida del paciente. Se reportan tres casos de cuerpo extraño como hallazgo incidental durante endoscopia digestiva alta y se realiza una revisión de la epidemiología de esta condición, así como la variedad de presentaciones clínicas según el órgano comprometido, complicaciones secundarias y aproximaciones diagnósticas. Finalmente se propone un diagrama de flujo diagnóstico y terapéutico que unifica los propuestos en la literatura médica.

Foreign body ingestion is a common condition in the emergency department. Although most objects get away without symptoms, events occur depending of their location and characteristics or may go unnoticed and later cause severe complications that threaten the patient’s life. We report three cases of foreign bodies identified during upper gastrointestinal endoscopy as an incidental finding and a review of the epidemiology of this condition, and the variety of clinical presentations depending on the organ involved, secondary complications and diagnostic approaches. Finally, we propose a flow chart diagnosis and treatment that unifies those proposed in the literature.

Prevalencia del trastorno de personalidad antisocial en pacientes consumidores de heroína, ubicados en cuatro barrios de la ciudad de Armenia, Quindío / Prevalence of antisocial personality disorder in heroin-consuming patients, located in four neighborhoods in the city of Armenia, Quindío

Se planteó indagar acerca de la existencia de trastorno de personalidad antisocial en consumidores de heroína, tomando una muestra de 10 heroinómanos, con edades comprendidas entre los 18 y 45 años, para lo cual se realiza un estudio cuantitativo ­ descriptivo de corte transversal, cuya población era de estrato socio-económico bajo, perteneciente a 4 barrios de la ciudad de Armenia. Para ello, se empleó un cuestionario elaborado bajo los criterios del Trastorno de Personalidad DisociaI/Antisocial evaluados por el Manual Diagnóstico y Estadístico de Trastornos Mentales (DSM-IV TR), valorado por expertos antes de su aplicación. Teniendo en cuenta los resultados más representativos, el 90% coincidió en ser impulsivos/agresivos y permaneció fuera de casa por un largo periodo de tiempo a pesar de las prohibiciones paternas, iniciando este comportamiento antes de los 13 años de edad. Asimismo el 80% hurtóobjetos sin generar daño a otro, presentó dificultad para mantener un empleo y mintió para satisfacer necesidades personales. De acuerdo a las cifras encontradas se sugiere la implementación de estrategias de prevención e intervención en políticas de salud mental.

One considered to investigate about the existence of upheaval of antisocial personality in heroin consumers, taking a sample from 10 heroin addicts,with ages between the 18 and 45 years, for which a quantitative study is realised - descriptive of it cross section, whose population era of low socio-economic layer, pertaining to 4 districts of the city of Armenia. For it, a questionnaire made under the criteria of the Upheaval of Antisocial DisociaI Personality was used/evaluated by the Manual Statistical Diagnosis and of Mental Upheavals (DSM-IV TR), valued by experts before its application. Considering the most representative results, 90% agreed in being impulsive/aggressive and remained abroad by a long period of time in spite of the paternal prohibitions, initiating this behavior before the 13 years of age. Also 80% stole objects without generating damage to another one, presented/displayed difficulty to maintain a use and lay to satisfy personal needs. According to the found numbers the implementation of strategies of prevention and intervention in policies of mental health is suggested.

Relevancia de las relaciones intrafamiliares en pacientes consumidores de heroína de la ciudad de Armenia / Relevance of intrafamily relations in heroin-consuming patients of the city of Armenia

Se propuso conocer la importancia de las relaciones intrafamiliares en consumidores de heroína, con una muestra de 10 heroinómanos que oscilan entre los 18 y 29 años de edad. Para ello se realiza un estudio cuantitativo-descriptivo de corte transversal con base a pacientes que asisten a consulta externa del Hospital Departamental Universitario del Quindío San Juan de Dios. Para tal fin, se utilizó una entrevista estructurada y el cuestionario de clima familiar de FES DE MOOS, que evalúan las relaciones interpersonales, aspectos de desarrollo y estructura básica. De acuerdo a los resultados obtenidos, el 100% coincide que la familia es el factor principal para recibir ayuda profesional; en cuanto a las subescalas los niveles más representativos fueron: conflicto (61.1), moralidad-religiosidad (55.5) y control (52.1).

It aimed to know the importance of intra-family relationships in heroin users, with a sample of 10 heroin addicts ranging between 18 and 29 years of age. For this quantitative study is performed descriptive cross-sectional basis to patients attending outpatient department of the Hospital Universitario del Quindío Departmental San Juan de Dios. To this end, we used a structured interview and questionnaire FES family environment of Moose, which assess interpersonal aspects of development and basic structure. According to results, 100% agree that the family is the main factor for professional help, and as for the subscales were more representative levels: conflict (61.1), moral-religious (55.5) and control (52.1).

Aplicación clínica de modelos terapéuticos no mediacionales en un caso de trastorno mixto del afecto / Clinical Implementation of Non Mediational Therapeutic Models in a Mixed Affective Disorder Case

El presente artículo expone un estudio de caso siguiendo la formulación analítica conductual y los componentes y principios de la intervención conductual planteados por la Terapia de Aceptación y Compromiso y la Psicoterapia Analítica Funcional, que retoma la importancia de la conducta verbal y sus características al momento de formular e intervenir en casos como el de un joven que acude a consulta psicológica con diagnóstico de trastorno depresivo y ansiedad por déficit en habilidades sociales, como en el presente caso en particular. Los resultados señalan la utilidad terapéutica de las estrategias empleadas, especialmente en el componente de compromiso y autocontrol que el consultante desarrolló. Discute además la pertinencia de abordar el caso clínico con énfasis en procesos cognitivo-verbales, desde modelos terapéuticos no mediacionales.

This paper presents a case study following the analytical formulation and behavioral components and principies of the behavioral intervention posed by Acceptance and Commitment Therapy and Functional Analytic Psychotherapy, which takes up the importance of verbal and their characteristics when formulating and in-tervening on cases such as the one of a young man who goes to psychological consultation with a diagnosis of depressive disorder and anxiety for déficits in social skills, as in this particular case. The results indícate the usefulness of the therapeutic strategies employed, particularly in the component of commitment and self-control that the consultant developed. The relevance of addressing the case with an emphasis on cognitive processes like verbal processes is discussed, from the use of non mediational therapeutic models.